Always in pain? Here’s Why…..

Rarely will you meet a woman in her child bearing years onwards who wouldn’t have her two bit to share on her experiences with pain. As a medical student I used to go mad history taking when Indian women would go on endlessly describing the discomfort of indigestion and gaseous distention and then the circuitous pathways the ‘gas’ will take in their pendulous bodies (my apologies!)finding its way to manifest as pain in lower back to knees to final in their upper storey, finally ending in a migraine. It wasn’t unusual then to see women walking into clinics with a band usually their scarf tied around their heads to combat the throbbing headaches. Not very much one could do those days apart from the red carminative mixture to take care of their ‘gas’ and paracetamol or soluble aspirin tablets. Over the years with the stress levels in women increasing, I wonder if the aches and pains too have increased substantially? Is it really true that the sensitivity to pain is determined by your gender, your stress level, and the latest kid on the block ‘your genes’?

In untangling the mystery of pain, there are just so many overlays of societal and cultural norms that go into the reporting of pain that may not have a biological basis at all. Even if there is a biological basis how does one go about testing the pain sensitivity? An important breakthrough came in the mid-1960s when scientists discovered that the brain could change the nervous system in response to pain. Up until then it was believed the nerve-brain-pain connection was fixed and inflexible. There is some experimental research that suggests the pain modulation systems between men and women may be different, females may also have an additional system that uses estrogen.

In the 1990’s it was discovered that pain begins when nociceptors — small, thin fibers located throughout the body in peripheral nerves — register trauma to nearby tissue. During surgery, for instance, nociceptors fire as soon as the initial incision is made. They release a bath of chemicals that induces the nerves to carry the pain message to the brain. The chemicals collect in a part of the spinal cord called the dorsal horn and are released to the brain — where pain is registered.

Even with general anesthesia, a patient’s central nervous system remains alert and ushers pain messages back and forth from the nociceptor, through the nerves, into the spinal cord, and on to the brain. The brain responds by washing the spinal cord with glutamate, a chemical that rewires the central nervous system and creates a physical memory of pain. How many of us remember that bone-splitting pain of our child births, I certainly don’t have words to describe that experience in terms of the intensity of pain of those final moments of pushing the baby out, certainly the memory remains despite all the pain relief provided at that point in time by modern obstetricians.

Pain management is big bucks as you can well see by the number of pain killer preps available even on supermarket shelves let alone pharmacies. The annual cost of pain in the U.S. alone is roughly $100 billion, including 515 million lost workdays, according to the American Pain Foundation. The interesting part for me is how laboratory studies show a clear difference in pain tolerance levels between men and women. When healthy men and women are subjected to heat and other types of pain tests, women almost always report feeling discomfort first. It takes a lower temperature for a women to tell you that this feels painful. The laboratory studies show rather convincingly that women have a lower pain threshold and pain tolerance than men.

Isn’t this contrary to the prevalent beliefs in our society that women are better at tolerating pain? What role does a woman’s menstrual cycle play in her perception of pain? It must play some part since most women know not to get their legs waxed right before their period because it is much more painful than at other times in their cycle. It is therefore a hormonal factor that is affects the perception of the pain, premenstrual phase women are more sensitive to most types of painful stimuli than during other phases of their cycle. So should we be looking at is that do we need to then have ‘Gender-Specific Treatments’?

Many of my physician colleagues share stories of women jumping up & down on procedure tables with pain despite the ‘n’ number of top-ups of pain relief meds. When the body is injured by accident or by the doctor making an incision, it releases a flood of pain-relieving substances, notably beta endorphins, a natural opioid. But many women’s bodies release fewer beta endorphins than men’s bodies do. Fewer natural painkillers can translate to more pain for women from the same injury — although, interestingly, women’s threshold for pain gets higher when they’re giving birth. This difference may have evolved because beta endorphins dull all of the five senses. If this theory of Maixner is right, it could explain studies that show women are more likely to develop conditions such as migraine headaches and to suffer more acutely after an operation. Individual differences seem to be due to genetic variations, Maixner says.

And this has been proven right very recently when the new ‘pain sensing’ gene PRDM12 essential to make our brains sensitive to pain was identified from rare individuals who are born unable to feel pain. This exciting discovery could lead to new pain relief methods since this new gene could be an excellent candidate for drug development from the discoverers at University of Cambridge. But why should we have the ability to feel pain? People who are born unable to feel pain — an inherited condition known as congenital insensitivity to pain (CIP) end up with many self-inflicted injuries often cutting their life short. Individuals affected by CIP carry two copies of the gene variant and the particular pain-sensing neurons were absent; however, if they had only inherited one copy from their parents, they were unaffected. Remember, the ability to sense pain is essential to our self-preservation, yet we understand far more about excessive pain than we do about lack of pain perception. Both are equally important to the development of new pain treatments – if we know the mechanisms that underlie pain sensation, we can then control and reduce unnecessary pain.

Also, we all know by experience that pain thresholds fluctuate. Stress and pain go together, life events, such as the death of a close friend or family member or job loss, can increase sensitivity to pain. On the other hand, a heightened sensitivity to the daily bumps and bruises of life can make you more stressed out — and even more thin-skinned. So we trap ourselves into a vicious cycle. What we women need is a way to learn how to deal with our low pain threshold. For a start, it helps to be upfront with your doctors. Ask without hesitation if any procedure feels painful for further top up of pain relief. During my labor pains the mid-wife at Royal Free Hospital, London kept asking me to practice the deep breathing learnt during the ante-natal classes but in my immaturity and dismissive attitude of a typical young physician I disregarded the importance of alternative measures. But older & wiser (or so I believe) I now know that practicing deep breathing, and listening to meditation tapes when one undergoes a procedure helps in mitigating the pain & discomfort. After all, deep breathing can reduce the production of epinephrine, a chemical that increases sensitivity to pain. Listening to relaxing music before, during, and after procedures to stay calm. Cognitive behavioral therapy can help you to learn how to cope with chronic pain. Even aerobic training increases pain tolerance in healthy individuals. The hypoalgesic (pain reducing) effects of acute exercise are well documented.

So ladies, any mother will tell you that if men had to go through the excruciating pain of childbirth the human race would have become extinct long ago. But that’s not all true despite what feminine lore told you before that guys simply don’t handle pain well. How many of us will raise our hands with their experiences with husbands , boyfriends etc. where the tiniest twinge of discomfort is enough to reduce them into helpless, whimpering heaps. Women, on the other hand, can handle the tough stuff & most women will soldier on without flinching. But the reality is that this is been proven wrong by science. We feel the pain more!